Research conducted by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention reveals that 1 in 4 adults using prescription stimulants engaged in misuse, and nearly 1 in 10 met the criteria for prescription stimulant use disorder (PSUD).

Findings show that amphetamine users were more likely to experience PSUD than those prescribed methylphenidate. Increased prescribing rates, particularly among middle-aged women, were observed, yet this demographic exhibited lower misuse rates than younger adults.

Concerns over stimulant misuse have grown as prescribing rates for these medications, commonly used to treat attention-deficit/hyperactivity disorder (ADHD), have increased. Clinical practice guidelines for adult ADHD remain absent, leading to variations in diagnosis and treatment. Questions about appropriate use persist as research indicates both the protective benefits of ADHD pharmacotherapy and its potential risks, including misuse, overprescription, and development of use disorders.

In the study, "Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years," published in JAMA Psychiatry, researchers conducted a cross-sectional survey study to understand patterns of prescription stimulant use and misuse among adults.

Stimulant prescribing trends from 2019 through 2022 were examined using pharmaceutical databases that captured 93% of outpatient prescriptions dispensed in U.S. retail pharmacies. Additional data on stimulant misuse, PSUD prevalence, and associated behavioral health conditions were drawn from the NSDUH survey results. Survey responses from 83,762 adults aged 18 to 64 years were analysed.

Results indicate that 25.3% of adults using prescription stimulants reported misuse, with 9.0% meeting the criteria for PSUD. Among those with PSUD, 72.9% used only their own prescribed stimulants, and 87.1% were prescribed amphetamines. Analysis revealed that amphetamine users were 3.1 times more likely to misuse their medication than those prescribed methylphenidate, with a 2.2 times greater likelihood of developing PSUD.

Prescriptions for stimulants increased across all demographics, with the most substantial rise occurring among women aged 35 to 64 years. Misuse of prescription stimulants was more common among individuals with depression, suicidal ideation, or concurrent substance use disorders. Women aged 35 to 64 years exhibited a lower prevalence of misuse than younger adults, with rates of 13.7% compared to 36.8% among women aged 18 to 25 years.

According to the study authors, "Our results underscore the importance of developing and implementing clinical practice guidelines for adult ADHD and strengthening evidence-based clinician training programs on adult ADHD diagnosis and multimodal care. Moreover, our findings highlight the need for prevention and intervention of prescription stimulant misuse, diversion, or PSUD regardless of misuse status and the reasons for prescribing stimulants."

--Justin Jackson